How to manage a fever

The proper management of fever is a basic self-care skill that everyone should possess, pandemic or no pandemic.

I have my herbs of choice, of course, but there are some basic kitchen remedies and wild herbs that will do just fine in their place. The only other things you need are a good thermometer, a nice cosy bed with lots of blankets, a shower or bathtub (optional), and a week or two off work.

Please note that this article is not intended as a substitute for conventional medical advice on COVID-19 - a link to the constantly updated online site for official COVID-19 medical information is provided below. This article is intended purely to educate and inform the curious patient faced with the task of monitoring and managing their own (or their loved ones’) fevers during a time where a visit to hospital is not encouraged.

In this article, therefore, I will go through what exactly fever is, how to monitor it, and how to treat each stage of fever properly based on the physiology of what is happening. Notice I say ‘monitor’ and ‘treat’ - not ‘suppress’ - which brings me to the most important point of all.

Although the French health minister who spoke up last month about the dangers of NSAIDs in the treatment of COVID-19 was criticised by public health entities, including the World Health Organisation (WHO) and the Centre for Disease Control (CDC), many frontline clinicians are now taking this into consideration.

In fact, the most reliable online source of medical information on COVID-19, the Internet Book of Critical Care (IBCC), has updated its chapter on COVID-19 to advise physicians to avoid all non-steroidal anti-inflammatory drugs in COVID-19 infection due to their capacity to upregulate virus-binding receptors on cells, worsen infection and cause kidney toxicity.

On a side note, it is interesting to mention that during the 1918 flu pandemic, routine medical treatment consisted of aspirin, paracetamol (acetanalide), morphine, digoxin (a heart drug) and diphtheria antitoxin. It now seems likely that this approach will have contributed significantly to the total mortality rate.

The recent change in guidelines is welcome to natural health practitioners like myself, who have always advocated for fever as a natural inflammatory process that should be supported rather than suppressed.

Aspirin, paracetamol and ibuprofen can make a fever worse

What is fever?

So, back to fever. Fever can be defined as a beneficial rise in body temperature and metabolism which aids the body’s immune reaction to invading bacteria and viruses. Along with it comes a boost in blood circulation, increased white blood cell and antibody production, and increased elimination via the skin and urine.

Fever is characterised by an elevated ‘set point’ on the body’s internal thermostat, the hypothalamus, with compensatory cooling mechanisms. For comparison purposes, hyperthermia (heat stroke) is a failure of compensatory cooling mechanisms with no elevated set point. While hyperthermia can cause neurological damage, the main concern with high fever is dehydration, metabolic exhaustion and, in cardiac patients, the destabilisation of arterial plaques and stroke.

In terms of the latest evidence relating to COVID-19, a high fever is more likely to indicate severe infection. The most common presentation however is said to be that of a ‘low-grade’ fever, which has specific implications for the individual patient.

Fever is a beneficial rise in body temperature which helps kill bacteria and viruses

Normal body temperature

To judge whether or not you have a ‘low-grade’ fever, you need to first know what your normal body temperature is. Contrary to popular belief, not every single person on the planet has a constant body temperature of 37ºC!

In fact, average body temperature tends to be around 36.8ºC, with variations of up to 0.5ºC throughout the day. Morning readings can be as low as 36ºC and afternoon readings as high as 37.7ºC - it depends entirely on the individual.

Older people also tend to have lower body temperatures - a temperature of 36.6ºC can indicate low-grade fever in an elder in some cases. This is important to be aware of considering that elders are high-risk patients when it comes to COVID-19.

In older people, a body temperature of 36.6ºC can indicate a low-grade fever

In order to diagnose a low-grade fever, you first need to get a feel for what your normal body temperature is, on rising and between 4-6pm. A rise of 0.25ºC above normal for that person at that specific time of day can be constituted as a low-grade fever. If working with an oral digital thermometer, make sure to take multiple readings until you get the same reading twice in a row. Avoid taking your temperature after eating hot food, drinking cold drinks or exercising, so as not to skew the reading.

Treatment of fever

Natural health practitioners may argue that fever does not need ‘treating’, and they wouldn’t be wrong. Fever IS the treatment, and your body’s immune system does the work. However, there are herbs and lifestyle approaches that can help fever run its course and support the basic physiological processes during each stage.

Stage 1

Think back to the last time you had a fever - what were the first signs? Usually, it’s chills, shivering, and someone might tell you you’re looking pale/ill and to go and lie down. The body’s ‘set point’ or internal thermostat has been elevated, and you’ve got some catching up to do.

One way of dealing with this initial stage is to take a short, hot shower before you get under the blankets, to open up the circulation and make it easier for the body to reach that set point.

Hot, warming ‘diaphoretic’ (sweat-inducing) herbs are indicated here. Think ginger, chilli, clove. I make my ginger tea so strong it’s completely opaque - almost milky in appearance - and it feels great at this stage. Milder stimulants also useful here include yarrow, feverfew and thyme.

However, the key aspect of initial fever management is fasting. Your body only produces a certain amount of protein each day, and during acute illness you need all the protein you can get for making white blood cells and immune peptides. You don’t want to be bothered with making digestive enzymes or regenerating your gut lining. Sticking to a water fast until the fever drops below 37.2ºC reduces fever duration and improves overall outcomes (see ‘sources’ below).

Ginger tea is great during the initial stages of fever

Stage 2

Once the fever has reached 38-39ºC, you’ll be feeling pretty relaxed and hopefully enjoying the time spent in bed, relieved of your daily duties. The skin will be hot and dry, but moisture is lost through the skin all the while making hydration critical at this stage.

Drink warm, soothing drinks with as many ‘demulcent’ herbs as you can get your hands on. Demulcents like mallow, plantain, marshmallow and slippery elm contain mucilage - gooey polysaccharides that keep the membranes moist and increase immune surveillance. They nourish the mucous membranes which become inflamed and damaged during influenza infections, producing the dry cough. Moistening the membranes will also improve local immune activity and help prevent the spread of infection to the lungs.

A good way to prepare a demulcent drink is to put a handful of the herb (fresh or dry) in the bottom of a 1.5 litre bottle of water, sip throughout the day. Marshmallow root will produce the sweetest and gooeyist of drinks - almost like a very watered down bowl of porridge - while marshmallow/mallow leaf and plantain will be less slimy.

Common mallow makes a nice demulcent drink

Other herbs to use during this stage are the cooling, relaxant diaphoretics - bonest (Eupatorium perfoliatum), elderberry and elderflower are good examples. These herbs relax the capillaries and increase heat lost by radiation through the skin. Take as teas alternating with your demulcents.

Stage 3

This is when the alternating fever and chills happen - the typical idea of fever in most people’s minds. The set point is fluctuating, with ‘cytokine surges’ - waves of inflammation which make you feel rubbish - coming and going in between periods of relief.

At this stage, it’s nice to have a simple tea formula made of stimulating and relaxant diaphoretics, such as the traditional yarrow, elderflower & peppermint combo. Yarrow is a gentle stimulant, elder is a cooling relaxant and peppermint is both stimulating and relaxing. Other useful gentle diaphoretic herbs for this stage include lemon balm, catmint and lime flowers.

It is also common to develop food cravings during this time - it is important to not give in to these and stick with your fast until your fever drops.

Stage 4

The set point falls, and you ‘sweat it out’. You will feel hot, and the sweating may come on gradually or happen quickly, soaking the bed sheets.

The most important thing here is to stay in bed as, although you will feel a little better, the illness has not yet run its course. Continue to hydrate, keep warm, and be patient. A retrospective study of the 1918 flu pandemic at Johns Hopkins Hospital concluded that “those who went to bed the earliest, stayed the longest, and had the best nursing care were most likely to survive”.

In COVID-19, symptoms can return after periods of respite, and a crisis point is often seen around day 10 in severe illness. Rest should therefore continue a full 10 days from the onset of symptoms. This does not mean you need to fast for 10 days - the fever itself should not last for more than a few days, following which you can start to eat soups, stews, fruits and other light nourishing meals.

Rest for a full 10 days if you suspect COVID-19 infection

Stage 5

This is the recovery stage. Take it easy - continue to rest as much as possible and don’t go back to work unless you really need to. Continue looking after yourself, eating good food and avoiding sugar and any known food intolerances.

At this stage you can take an omega-3 supplement if that’s not already part of your daily routine. Adaptogens are also useful as you’ll be feeling pretty run down still, with possible dizziness, thirst and sensitivity to hot or cold. Liquorice is a great adaptogen here - a demulcent ‘qi tonic’ (chinese medicine) which puts a bit of spring in your step. Other nourishing adaptogens include ashwagandha and shatavari.

It is normal to still feel a little tired in the weeks following a fever, but if this develops into long-term fatigue you may need to see a natural health practitioner about it. Poorly managed fevers can develop into complex symptom pictures like Chronic Fatigue Syndrome, so it’s important that you give your fever the attention it deserves in the initial stages, to prevent this from happening.

General fever protocol

To recap - a general herbal protocol for influenza fever treatment would look something like this:

Herbs to avoid

Many of our traditional herbs for cough, like thyme, elecampane, coltsfoot and white horehound, are ‘stimulating expectorants’. They act by irritating the mucous membranes, stimulating cough and promoting the expectoration of stuck mucous in the lungs. In cases of dry cough however, these types of herbs may be overly irritant to an already inflamed and damaged membrane. This is why it’s best to stick to the ‘demulcent expectorants’ mentioned above - marshmallow, plantain, mallow and slippery elm.

Lastly, boneset - which is effective as a relaxant diaphoretic and also on exposure to the virus, should not be taken for more than 2 weeks at a time due to its pyrrolizidine alkaloid content.

Phew, this was a long one folks! If you made it to the end - congrats, you now know how to effectively manage a fever. Coming soon: more local wild immune-boosting herbs you can use to bolster your defences over the coming months. Stay tuned ;-)

Sources:

Much of this is based on the writings and teachings of herbalist Paul Bergner in the United States, whose approach to fever management originates from his own education in the medical arts in the 1970s. He has reported widespread success with this method, which abides by the simple laws of nature and logic.